Since the 1950s fluoride has played an important role in the fight against tooth decay as an additive to hygiene products and many public water supplies. But although a proven cavity fighter, some have questioned its safety over the years.

To date, though, the only substantiated health risk from fluoride use is a condition known as enamel fluorosis, which occurs when too much fluoride is ingested during early tooth development as the mineral embeds in the tooth structure. Fluorosis can cause changes in the enamel’s appearance, ranging from barely noticeable white streaking to darker visible staining and a pitted texture.

Fluorosis is primarily a cosmetic problem and not a serious health issue. The staining on otherwise sound teeth, however, is permanent and more severe cases may require extensive bleaching treatment to improve appearance. The best strategy is to prevent fluorosis by monitoring and limiting your child’s fluoride intake, until about age 9.

Tooth decay is a more serious condition than fluorosis so we’re not advocating you eliminate fluoride but that you keep your family’s intake within safe levels. The first step is to determine just how much that intake is now, particularly if you drink fluoridated water. If you have public water, you may be able to find its fluoridation level online at apps.nccd.cdc.gov or call the utility directly.

You should also be careful about the amount of toothpaste your child uses to brush their teeth. Children under two need only a trace (a “smear”) on the brush, and children between the ages of 2 and 6 a pea-sized amount. And, they should brush no more than twice a day.

Another possible concern is infant formula, especially mixable powder. While the formula itself doesn’t contain fluoride, water mixed with it may. If you live in an area with increased fluorosis risk, consider breast-feeding (breast milk has little fluoride), using ready-to-feed formula, or mixing powdered formula with bottled water labeled “de-ionized,” “purified,” “demineralized” or “distilled.”

We’ll be glad to help assess your family’s current fluoride intake and advise you on making adjustments to bring it into normal ranges. Taking in the right amount of fluoride assures you and your children receive the most benefit and protection from it, while avoiding future smile problems.